Interesting article-Pharmacist committing insurance fraud

[triples15]

Hi All!!

This article immediately made me think of Liza's (Ratatosk) situation with finding her pharmacy was billing her insurance for Tobi that she never ordered or received....This is a pharmacy in the Nebraska town we just moved from. There is not a CF clinic in Lincoln at all, but it says this guy was filling scripts (well not filling them, just submitting claims) allegedly written by 6 different local doctors for Tobi. Ugh. A good reminder to us all to periodically check to see what's being billed to our insurance companies.

http://journalstar.com/news/local/l...cle_1c50ff8f-8653-50b2-83b2-56dd20414bb3.html

Autumn 34 w/Cf

 

[nmw0615]

Thank you for sharing this, Autumn. I get extremely frustrated with my insurance company not approving medications, but this is a nice reminder to view the medication from their point of view as well.

 

[ethan508]

I wonder how much more affordable life would be without fraud and dishonesty. Shoplifting, falsely used credit card numbers, security fraud, unreported taxes, Medicare/health care fraud, and the price to police it all end up costing those that are willing to be honest.

Sometimes it doesn't feel like the victim company is really hurt too bad by it (what is $30k-40k to a multi-million dollar company). But these costs always seem to be passed down to us.

 

[triples15]

Thank you for sharing this, Autumn. I get extremely frustrated with my insurance company not approving medications, but this is a nice reminder to view the medication from their point of view as well.

Exactly, now the next time they tell me that we're waiting on a "prior authorization" I'll try to be a little more understanding.

Really though, Tobi almost always requires a prior authorization, which requires the prescribing doctor to fill something out. So if these docs weren't writing the scripts I'm trying to figure out how he did this for years!!

 

[triples15]

I wonder how much more affordable life would be without fraud and dishonesty. Shoplifting, falsely used credit card numbers, security fraud, unreported taxes, Medicare/health care fraud, and the price to police it all end up costing those that are willing to be honest.

Sometimes it doesn't feel like the victim company is really hurt too bad by it (what is $30k-40k to a multi-million dollar company). But these costs always seem to be passed down to us.

Yep, exactly. In this case the guy bilked the State's Medicaid program for over 2.5 million dollars, just on Tobi. We all know the funding problems Medicaid has in every state, so this is just sickening to me. That money could have gone so many other places.

 

[2005CFmom]

Years ago my brother worked for a company that self insured. He was in management so he saw the bills that came through. My sister took one of their kids to the ped. The bill came through for all three of their kids visiting the doctor. He only caught this because it was his own kids and knew this wasn't right. There is probably more fraud out there than anyone knows!

 

[Aboveallislove]

I wonder how much more affordable life would be without fraud and dishonesty. Shoplifting, falsely used credit card numbers, security fraud, unreported taxes, Medicare/health care fraud, and the price to police it all end up costing those that are willing to be honest.

Sometimes it doesn't feel like the victim company is really hurt too bad by it (what is $30k-40k to a multi-million dollar company). But these costs always seem to be passed down to us.

Totally agree! The fraud involved in insurance and medicare and medcaid affect so many!

And I think your absolutely right about what I call "socking it to the big bad evil corporations." Before marrying and becoming a mom I taught undergrads at a religious school and during "ethics week" I did a set of hypos where I basically pushed everyone to answer questions until in the end nearly the entire class admitted that my hypo was "steeling cable" and that they would still all do it. I always asked why? (well beside original sin!) and I still remember the student who explained about how much money these corporations had etc. I pointed out that the day they graduate and start their first job they'll have more money and things than 90% of the population and that rationale might one day be used against them! Boy, I sure do miss teaching....that was fun!

 

[Ratatosk]

Wow! Crazy thing with us was we couldn't get approval from Our insurance because we'd supposedly ordered the drug. And I didn't know the national, mail order pharmacy that was also a subsidiary of our insurance company was submitting claims until I received the quarterly statement of benefits showing claims every month (Tobi is every other month). Googling the national pharmacy, came up with similar claims from people and we were told it was just a glitch. Thank goodness a generic came out and we were able to get our meds from our local pharmacist, who is also a relative.